Early symptoms of avascular necrosis don't include that much pain because the bone is still structurally intact. It's the later stages of AVN that really is very painful for patients, because it's almost like a fracture because the bone has indent in it because it then collapses down. If you get to avascular necrosis early enough, there are treatment options such as decompression, where they can actually decompress the area just underneath that bone, prior to collapse, and therefore stimulate the bone to have improvement in the vascular supply. Most patients, however, don't present that early and are later presentation, when the bone has already started to collapse. We treat these patients similarly to advanced stages of osteoarthritis, because it's that collapsed, that then leads to further degradation of the overlying cartilage on top and therefore increased pain. Patients with avascular necrosis of the femoral head will often require hip replacement surgery at some point in their lifetime, especially if the bone has already started to show signs of collapse. This is because once the collapse starts, it's almost like a fracture and it's very painful to walk on the hip.
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